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Oath Or Declaration & Power Of Atty--Orig. Application
OATH OR DECLARATION & POWER OF ATTY-ORIG. APPLICATION
State of [State]
County of [County]
My name, address, citizenship, and residence are as follows:
[name, address, citizenship, and residence of inventor]
Full name of inventor: [Full name of inventor]
Citizenship: [Citizenship of inventor]
Residence: [Residence of inventor]
Post Office Address: [Post Office Address of inventor]
I, [Full name of inventor], [declare that/being duly sworn, depose and say that] I am the original inventor of the invention titled [Title of Invention] which I have described and claimed in the attached specification.
To the best of my knowledge and belief, this design was never known or used in the United States prior to my invention of it. Nor was it ever patented or offered for public sale prior to that time. I recognize that I have a duty to disclose material information pertaining to this application of which I am aware.
I appoint [Name of attorney] as my attorney and/or agent for the purpose of prosecuting this application and for conducting all business in the Patent and Trademark Office in connection therewith.
All telephone calls and all correspondence should be addressed to:
[Name of agent]
[Telephone Number of agent]
[Complete Address of agent]
To the best of my knowledge and belief, all the statements made herein are true and were made with the knowledge that willful false statements are unlawful and are punishable by fine or imprisonment, or both
Signature Date